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Bersang AK, Rashu BS, Niebuhr MH, Fode M, Thomsen FF. Robot-assisted laparoscopic Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction. J Robot Surg 2024; 18:355. [PMID: 39340628 PMCID: PMC11438722 DOI: 10.1007/s11701-024-02098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024]
Abstract
OBJECTIVES To explore surgical, functional, and symptomatic outcomes in a series of patients who underwent robot-assisted laparoscopic Anderson-Hynes pyeloplasty (RALP) for ureteropelvic junction obstruction using the DaVinci Si surgical robotic system. METHODS Retrospective study including patients aged 16 years or older who underwent RALP from June 2016 to December2021. The following outcomes were recorded: operative outcome and complications [classified according to the Clavien-Dindo Classification (CD)] within 30 days of the procedure as well as 1 year success rate and restenosis during follow-up. RESULTS In total, 194 patients were available for analyses with a median follow-up of 4.5 (IQR 3.0-6.0) years. The primary indications were loss of kidney function (45%), pain (36%), infection (11%), kidney stone (6%), and others (2%). The median operation time was 134 min (IQR 112-159), the median length of stay was 2 days (IQR 2-2), and the median time with double-j stent postoperatively was 24 days (IQR 22-27). Overall, 65 out of 194 patients (33%) experienced a postoperative complication (12% CD I, 13% CD II, 8% CD IIIa or IIIb). The 1 year success rate was 92% for patients treated because of deteriorating renal function, 78% for patients treated because of symptoms, 82% for patients treated because of infections, and 78% for patients treated because of kidney stones. Seven percent of the patients presented a recurrent ureteropelvic junction stricture during follow-up. CONCLUSIONS In our experience, robot-assisted laparoscopic Anderson-Hynes pyeloplasty performed with the DaVinci Si system is a safe with a few major complications and acceptable success rate.
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Affiliation(s)
- Ann Kortbæk Bersang
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark.
| | - Badal Sheikho Rashu
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Malene Hartwig Niebuhr
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Mikkel Fode
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Frederik Ferløv Thomsen
- Department of Urology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
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Popelin MB, Pinar U, Benamran D, Ingels A, Parra J, Vaessen C, Seisen T, de La Taille A, Roupret M. Functional outcomes after robot-assisted pyeloplasty for ureteropelvic junction obstruction: A bi-centre experience. Int J Med Robot 2020; 17:e2201. [PMID: 33175444 DOI: 10.1002/rcs.2201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/12/2020] [Accepted: 11/05/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Robot-assisted pyeloplasty (RALP) for patients with clinically symptomatic ureteropelvic junction obstruction (UPJO) is increasing and needs assessment. METHODS Patients who underwent RALP for UPJO in two academic centres were included. Demographic and perioperative data were collected retrospectively. UPJO was evaluated by imaging pre- and post-surgery. Patients had follow-up consultations 3,6 and 12 months post-surgery. Global success was defined as a clinical response plus radiographic evidence of no further obstruction 3-months post-surgery. RESULTS Overall 214 patients (median age: 40 years [interquartile range:30.3-54.0]) were included. Fourteen patients (6.5%) had undergone previous surgery for UPJO. Thirty patients (14%) suffered complication: urinoma (n = 13; 6.1%), pyelonephritis (n = 15; 7%) and retroperitoneal haematomas (n = 2; 0.9%). Repeated early surgery was necessary in eight patients (3.6%). Seven patients had a recurrence of UPJO and six (2.9%) underwent repeated surgery. Radiological success rate was 96.7% whereas global success rate was 91%. CONCLUSIONS RALP was a reliable, effective and safe treatment for UPJO with a high global and radiologic success rate.
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Affiliation(s)
- Marie-Bérénice Popelin
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Paris, France
| | - Ugo Pinar
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Paris, France
| | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandre Ingels
- Hôpitaux Universitaires Henri Mondor, APHP, Henri Mondor Hôpital, Urology, Créteil, France
| | - Jérome Parra
- Department of Urology, Sorbonne University, APHP, Pitié-Salpêtrière Hôpital, Paris, France
| | - Christophe Vaessen
- Department of Urology, Sorbonne University, APHP, Pitié-Salpêtrière Hôpital, Paris, France
| | - Thomas Seisen
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Paris, France
| | - Alexandre de La Taille
- Hôpitaux Universitaires Henri Mondor, APHP, Henri Mondor Hôpital, Urology, Créteil, France
| | - Morgan Roupret
- Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Paris, France
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Seetharam Bhat KR, Moschovas MC, Patel VR, Ko YH. The robot-assisted ureteral reconstruction in adult: A narrative review on the surgical techniques and contemporary outcomes. Asian J Urol 2020; 8:38-49. [PMID: 33569271 PMCID: PMC7859418 DOI: 10.1016/j.ajur.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Despite the rapid increase in the use of robotic surgery in urology, the majority of ureteric reconstruction procedures are still performed using laparoscopic or open approaches. This is primarily due to uncertainty regarding the advantages of robotic approaches over conventional ones, and the unique difficulty in identifying the specific area of interest due to the lack of tactile feedback from the current robotic systems. However, with the potential benefits of minimal invasiveness, several pioneering reports have been published on robotic surgery in urology. By reviewing the literature on this topic, we aimed to summarize the techniques, considerations, and consistent findings regarding robotic ureteral reconstruction in adults. Robotic applications for ureteral surgery have been primarily reported for pediatric urology, especially in the context of relieving a congenital obstruction in the ureteral pelvic junction. However, contemporary studies have also consistently demonstrated that robotic surgery could be a reliable option for malignant, iatrogenic, and traumatic conditions, which generally occur in adult patients. Nevertheless, the lack of comparative studies on heterogeneous hosts and disease conditions make it difficult to determine the benefit of the robotic approach over the conventional approach in the general population; thus, qualified prospective trials are needed for wider acceptance. However, contemporary reports have demonstrated that the robotic approach could be an alternative option for ureteral construction, even in the absence of haptic feedback, which can be compensated by various surgical techniques and enhanced three-dimensional visualization.
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Affiliation(s)
| | - Marcio Covas Moschovas
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Vipul R Patel
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Young Hwii Ko
- Department of Urology, Yeungnam University, Daegu, Republic of Korea
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Mizuno K, Kojima Y, Kurokawa S, Kamisawa H, Nishio H, Moritoki Y, Nakane A, Maruyama T, Okada A, Kawai N, Tozawa K, Kohri K, Yasui T, Hayashi Y. Robot-assisted laparoscopic pyeloplasty for ureteropelvic junction obstruction: comparison between pediatric and adult patients-Japanese series. J Robot Surg 2016; 11:151-157. [DOI: 10.1007/s11701-016-0633-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/23/2016] [Indexed: 01/19/2023]
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Abstract
Since 2005 when the da Vinci surgical system was approved as a medical device by the Korean Ministry of Health and Welfare, 51 systems have been installed in 40 institutions as of May 2015. Although robotic surgery is not covered by the national health insurance service in Korea, it has been used in several urologic fields as a less invasive surgery. Since the first robotic-assisted laparoscopic radical prostatectomy in 2005, partial nephrectomy, radical cystectomy, pyeloplasty, and other urologic surgeries have been performed. The following should be considered to extend the indications for robotic surgery: training systems including accreditation, operative outcomes from follow-up results, and cost-effectiveness. In this review, the history and current status of robotic surgeries in Korea are presented.
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Affiliation(s)
- Ill Young Seo
- Department of Urology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
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Stentless pyeloplasty for ureteropelvic junction obstruction in children. ANNALS OF PEDIATRIC SURGERY 2015. [DOI: 10.1097/01.xps.0000455092.43161.ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Samarasekera D, Stein RJ. Robotic-assisted laparoscopic approaches to the ureter: Pyeloplasty and ureteral reimplantation. Indian J Urol 2014; 30:293-9. [PMID: 25097316 PMCID: PMC4120217 DOI: 10.4103/0970-1591.128503] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The benefits of robotic surgery when compared to standard laparoscopy have been well established, especially when it comes to reconstructive procedures. The application of robotic technology to laparoscopic pyeloplasty has reduced the steep learning curve associated with the procedure. Consequently, this has allowed surgeons who are less experienced with laparoscopy to offer this treatment to their patients, instead of referring them to centers of excellence. Robotic pyeloplasty has also proved useful for repairing secondary UPJO, a procedure which is considered extremely difficult using a conventional laparoscopic approach. Finally, the pursuit of scarless surgery has seen the development of laparoendoscopic single site (LESS) procedures. The application of robotics to LESS (R-LESS) has also reduced the difficulty in performing conventional LESS pyeloplasty. Herein we present a literature review with regards to robotic-assisted laparoscopic pyeloplasty. We also discuss the benefits of robotic surgery with regards to reconstruction of the lower urinary tract. MATERIALS AND METHODS A systematic literature review was performed using PubMed to identify relevant studies. There were no time restrictions applied to the search, but only studies in English were included. We utilized the following search terms: Ureteropelvic junction obstruction and laparoscopy; laparoscopic pyeloplasty; robotic pyeloplasty; robotic ureteric reimplantation; robotic ureteroneocystostomy; robotic boari flap; robotic psoas hitch. RESULTS There has been considerable experience in the literature with robotic pyeloplasty. Unfortunately, no prospective randomized studies have been conducted, however there are a number of meta analyses and systematic reviews. While there are no clear benefits when it comes to surgical and functional outcomes when compared to standard laparoscopic pyeloplasty, it is clear that robotics makes the operation easier to perform. There is also a benefit to the robotic approach when performing a redo-pyeloplasty. Robotic pyeloplasty has also been applied to the pediatric population, and there may be a benefit in older children while in very young patients, retroperitoneal open pyeloplasty is still the gold standard. In the field of single incision surgery R-LESS is technically easier to perform than conventional LESS. However, the design of the current robotic platform is not completely suited for this application, limiting its utility and often requiring a larger incision. Optimized R-LESS specific technology is awaited. What is clear, from a number of analyses, is that robotic pyeloplasty is considerably more expensive than the laparoscopic approach, largely due to costs of instrumentation and the capital expense of the robot. Until cheaper robotic technology is available, this technique will continue to be expensive, and a cost-benefit analysis must be undertaken by each hospital planning to undertake this surgery. Finally, the benefits of upper tract reconstruction apply equally to the lower tract although there is considerably less experience. However, there have been a number of studies demonstrating the technical feasibility of ureteral reimplantation. CONCLUSIONS Robotic-assisted laparoscopic pyeloplasty is gaining popularity, likely due to the shorter learning curve, greater surgeon comfort, and easier intracorporeal suturing. This has allowed more surgeons to perform the procedure, improving accessibility. Robotic technology is also beneficial in the field of LESS. Nevertheless, the procedure still is not as cost-effective as the conventional laparoscopic approach, and until more affordable robotic technology is available, it will not be universally offered.
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Affiliation(s)
- Dinesh Samarasekera
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert J Stein
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Pahwa M, Pahwa AR, Girotra M, Abrahm RR, Kathuria S, Sharma A. Defining the pros and cons of open, conventional laparoscopy, and robot-assisted pyeloplasty in a developing nation. Adv Urol 2014; 2014:850156. [PMID: 24624138 PMCID: PMC3929287 DOI: 10.1155/2014/850156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/08/2013] [Accepted: 12/15/2013] [Indexed: 12/01/2022] Open
Abstract
Introduction. Congenital pelviureteric junction obstruction (PUJO) is one of the most common causes of hydronephrosis. Historically, open dismembered pyeloplasty has been considered the gold standard intervention for correcting PUJO. The aim of this study was to compare the surgical and functional outcomes of three different approaches, namely, open, conventional laparoscopy, and robotic pyeloplasty. Material and Methods. 60 patients underwent minimally invasive pyeloplasty (30 conventional laparoscopies and 30 robotics) for congenital PUJO at a tertiary health center in India. Demographic, perioperative, and postoperative data were prospectively collected and analyzed. The data of these patients were retrospectively compared with another cohort of 30 patients who had undergone open pyeloplasty. Results. There was significant difference in operative time, time to drain removal, hospital stay, pain score, and complications rate between open and minimally invasive pyeloplasty (P < 0.05). SFI was considerably lesser in robotic as compared to conventional laparoscopy. The success rate in OP, CLP, and RP was 93.33, 96.67, and 96.67%. Conclusion. Robotic pyeloplasty is safe, effective, and feasible. It is associated with significantly lesser operative time, lesser blood loss, less pain, shorter hospital stay, and fewer complications. It is also associated with considerably lesser surgeon fatigue as compared to conventional laparoscopy pyeloplasty.
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Affiliation(s)
- Mrinal Pahwa
- Sir Ganga Ram Hospital, 78-c, Mianwali Colony, Gurgaon 122001, India
| | | | - Mohit Girotra
- University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | | | - Sachin Kathuria
- Sir Ganga Ram Hospital, 78-c, Mianwali Colony, Gurgaon 122001, India
| | - Ajay Sharma
- Sir Ganga Ram Hospital, 78-c, Mianwali Colony, Gurgaon 122001, India
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Faddegon S, Granberg C, Tan YK, Gargollo PC, Cadeddu JA. Minimally Invasive Pyeloplasty in Horseshoe Kidneys with Ureteropelvic Junction obstruction: A case series. Int Braz J Urol 2013; 39:195-202. [DOI: 10.1590/s1677-5538.ibju.2013.02.07] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 12/21/2012] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | - Yung K Tan
- University of Texas Southwestern Medical Center, USA
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Moreno-Sierra J, Castillon-Vela I, Ortiz-Oshiro E, Galante-Romo I, Fernandez-Perez C, Senovilla-Perez JL, Casado-Varela J, Garde-Garcia H, Chavez-Roa C, Vera-Gonzalez V. Robotic Anderson-Hynes dismembered pyeloplasty: initial experience. Int J Med Robot 2013; 9:127-33. [PMID: 23408585 DOI: 10.1002/rcs.1473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The introduction of the da Vinci(®) robotic system in 2000 has been a new step forward in the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study was to analyse our initial experience with robot-assisted dismembered Anderson-Hynes pyeloplasty and to perform a bibliographic review on the topic. PATIENTS AND METHODS We performed 11 robot-assisted pyeloplasties between March 2007 and April 2011. UPJO diagnosis was made on clinical presentation and imaging techniques (CT scan and intravenous urography). All patients underwent basal and diuretic isotopic renograms to evaluate the degree of obstruction and impaired renal function. Median follow-up was 10 (range 1-26) months. RESULTS Mean patient age was 38.8 (range 23-62) years. There were six women (55%) and five men (45%). All cases were primary surgeries. In four patients the cause of UPJO was a crossing vessel; the other seven patients had intrinsic obstruction. One case was associated with extraction of a calyceal lithiasis. Mean operative time was 189.4 min (125-270 min). Average time from robotic arms docking was 116.5 (range 55-180) min. Average hospital stay was 4.18 (range 2-8) days. Conversion to open or laparoscopic surgery was not necessary in any case and there were no postoperative complications. Postoperative radiological evaluation and renograms showed good results in all cases. CONCLUSIONS Robotic surgery offers better ergonomics, enhanced three-dimensional (3D) vision and more precise movements, easing intracorporeal suturing.These advantages make robotic pyeloplasty a reproducible technique that combines the high success rates of open surgery and the benefits of laparoscopic surgery.
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Affiliation(s)
- Jesús Moreno-Sierra
- Urology Department, Instituto de Investigación Sanitaria, Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain.
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Economic evaluation of da Vinci-assisted robotic surgery: a systematic review. Surg Endosc 2011; 26:598-606. [PMID: 21993935 DOI: 10.1007/s00464-011-1936-2] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 09/11/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Health technology assessment (HTA) is frequently used when a new and expensive technology is being introduced into clinical practice. This certainly is the case with the da Vinci surgical robot, with costs ranging from $1 to $2.5 million for each unit. This systematic review documents major variability in the reported cost evaluation studies of da Vinci robot-assisted operations compared with those performed by the direct manual laparoscopic approach. METHODS Published studies in the English language related to the period 2000-2010 were searched using economic and clinical electronic databases. RESULTS All 11 reports included some form of cost analysis, which made it possible for the authors to extract information on certain specific economic outcomes: operating room time, hospital stay, and total costs. With the exception of two studies, the reported operating room time was higher with the robotic approach than with manual laparoscopic surgery, and the hospital stay was the same for the two techniques. Robotic surgery is significantly more expensive if the purchase and maintenance costs of the robot system are included in the total costs. Only 3 of the 11 publications included these costs. CONCLUSIONS The disadvantage of robotic surgery is its higher costs related to purchase and maintenance of technology and its longer operating room time. However, emerging evidence shows that operating room time decreases with experience using the robot. From the HTA viewpoint, the result of this review is that the jury still is out on the HTA of da Vinci-assisted robotic surgery.
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